Our Summary

A 70-year-old man came to the doctor with new heart problems, mainly affecting the right side of his heart. Using an ultrasound scan of his heart, the doctors found signs of heart disease caused by high blood pressure, and thought he might also have a condition called constrictive pericarditis (CP), where the sac around the heart becomes stiff and affects its ability to function properly. However, a CT scan only showed a slightly thicker than normal sac.

To investigate further, they measured the pressures inside the man’s heart and found that they were higher than normal and the same in all parts of the heart. Also, the heart filled up with blood quickly after each beat. Although these findings could indicate CP, the fact that the pressures within the heart and chest were not disconnected and that the two chambers of the heart were not dependent on each other suggested there could be a different problem.

The doctors decided to perform an operation to remove part of the sac around the heart. After the operation, the pressure in the man’s veins decreased significantly. Examination of the removed sac revealed it was fibrous, which confirmed CP. The man’s heart problems improved considerably after the operation.

The doctors think the reason why the man’s condition didn’t meet all the criteria for CP might be because he also had heart disease caused by high blood pressure. They concluded that CP should be considered when treating patients with heart failure, as the tests needed to diagnose it can be complex and the treatment can potentially cure the condition.

FAQs

  1. What diagnostic procedures were used to identify constrictive pericarditis in the 70-year-old patient?
  2. What was the outcome of the diagnostic pericardiectomy performed on the patient?
  3. How does hypertensive heart disease potentially influence the diagnosis of constrictive pericarditis?

Doctor’s Tip

A helpful tip a doctor might give a patient about pericardiectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and gradually increasing physical activity as allowed by the medical team. It is important to communicate any new or worsening symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for pericardiectomy are those with constrictive pericarditis (CP) who have symptoms of heart failure, such as difficulty breathing, fatigue, and swelling in the legs. In some cases, patients may also have a history of pericardial disease, such as recurrent pericarditis or pericardial effusions. Diagnostic evaluation for CP may include echocardiogram, CT scan, and right heart catheterisation to assess for features such as equalisation of diastolic pressures in all cardiac chambers, ventricular interdependence, and dissociation of intrathoracic and intracardiac pressures. Pericardiectomy may be recommended for patients with confirmed CP who do not respond to medical therapy or have severe symptoms.

Timeline

  • Patient presents with recent onset right-sided heart failure
  • Echocardiogram shows features of hypertensive heart disease and suggests constrictive pericarditis
  • CT demonstrates mild pericardial thickening
  • Right heart catheterisation shows elevation and equalisation of diastolic pressures in all cardiac chambers
  • Diagnostic pericardiectomy is performed
  • Central venous pressure decreases post-pericardiectomy
  • Pathology reveals pericardial fibrosis
  • Patient experiences sustained resolution of heart failure

Overall timeline:

  • Presentation of symptoms and diagnostic testing
  • Diagnosis of constrictive pericarditis
  • Pericardiectomy
  • Resolution of heart failure symptoms

What to Ask Your Doctor

  1. What is a pericardiectomy and how is it performed?
  2. What are the potential risks and complications associated with a pericardiectomy?
  3. How will a pericardiectomy benefit me in managing my condition?
  4. How long is the recovery period after a pericardiectomy?
  5. Are there any lifestyle changes or medications that I will need to take after the procedure?
  6. What follow-up appointments or tests will be necessary after the pericardiectomy?
  7. Are there any alternative treatments or procedures available for my condition?
  8. What is the success rate of pericardiectomy in patients with similar conditions?
  9. How will a pericardiectomy affect my overall quality of life?
  10. Are there any long-term effects or complications that I should be aware of after the procedure?

Reference

Authors: Konik E, Geske J, Edwards W, Gersh B. Journal: BMJ Case Rep. 2016 Nov 14;2016:bcr2016217563. doi: 10.1136/bcr-2016-217563. PMID: 27873763